Respiratory Syncytial Virus (RSV) Infection

Topic Overview

What is respiratory syncytial virus infection?

Respiratory syncytial virus infection,
usually called RSV, is a lot like a bad cold. It causes the same symptoms. And
like a cold, it is very common and very contagious. Most children have had it
at least once by age 2.

RSV is usually not something to worry
about. But it can lead to
pneumonia or other problems in some people, especially
babies. So it's important to watch the symptoms and call your doctor if they
get worse.

What causes RSV infection?

A virus causes RSV
infection. Like a cold virus, RSV attacks your nose, eyes, throat, and lungs.
It spreads like a cold too, when you cough, sneeze, or share food or
drinks.

There are many kinds of RSV, so your body never becomes
immune to it. You can get it again and again
throughout your life, sometimes during the same season.

What are the symptoms?

RSV usually causes the same
symptoms as a bad cold, such as:

A cough.

A stuffy or runny nose.

A mild sore throat.

An earache.

A fever.

Babies with RSV may also:

Have no energy.

Act fussy or cranky.

Be less hungry than usual.

Some children have more serious symptoms, like wheezing.
Call your doctor if your child is wheezing or having trouble breathing.

How is RSV diagnosed?

Doctors usually diagnose RSV
by asking about your or your child's symptoms and by knowing whether there is
an outbreak of the infection in your area.

There are tests for
RSV, but they aren't usually needed. Your doctor may want to do testing if you
or your child may be likely to have other problems. The most common test uses a
sample of the drainage from your nose.

How is it treated?

RSV usually goes away on its
own. For most people, home treatment is all that is needed. If your child has
RSV:

Prop up your child's head to make it easier to breathe and
sleep.

Suction your baby's nose if he or she can't breathe well enough
to eat or sleep.

Relieve fever with acetaminophen or ibuprofen, if needed. Never give
aspirin to someone younger than 20 years, because it can cause
Reye syndrome, a serious but rare problem.

When a person with RSV is otherwise healthy, symptoms
usually get better in a week or two.

RSV can be serious when the
symptoms are very bad or when it leads to other problems, like pneumonia.
Certain people are more likely to have problems with RSV:

Babies younger than 6 months, especially those born early (prematurely)

People with
immune system problems

People with heart or lung problems

Adults older than 65

These people sometimes need treatment in a hospital. So
it's important to watch the symptoms and call your doctor if they get
worse.

Can you prevent RSV infection?

It's very hard to
keep from catching RSV, just like it's hard to keep from catching a cold. But
you can lower the chances by practicing good health habits. Wash your hands
often, and teach your child to do the same. See that your child gets all the
vaccines your doctor recommends.

Medicines to prevent RSV may be given to babies and children who are more
likely to have problems with the infection. Sometimes these medicines don't
prevent RSV, but they may keep symptoms from getting serious.

Cause

Respiratory syncytial virus (RSV) is
highly contagious, meaning it spreads easily from person to person. There are
two main types of RSV and many subtypes (strains). For this reason, you cannot
have full
immunity to the virus. And you may have many RSV
infections throughout life.

People with RSV infection may spread
the virus through their secretions (saliva or mucus) when they cough, sneeze,
or talk. You can catch the virus by:

Touching an object or surface contaminated with the virus and
then touching your nose, eyes, or mouth without first washing your hands. The
virus can survive for more than 6 hours on countertops and other hard surfaces,
such as doorknobs, and for 30 minutes on hands, clothing, or tissue.

Close contact. If an infected person coughs or sneezes near you,
you could breathe in RSV that's in his or her saliva or mucus.

The virus spreads easily in crowded settings, such as child
care facilities, preschools, and nursing homes. Children attending
school often spread the virus to their parents and siblings. The incubation
period—the time from exposure to RSV until you have symptoms—ranges from 2 to 8
days but usually is 4 to 6 days.1

You
are most likely to spread the virus within the first several days after
symptoms of RSV infection begin. You remain contagious for up to 8 days. Babies and young children may spread the virus for at least 3 to 4
weeks.

Many different viruses can cause lower
respiratory tract infections in children. These viruses can cause symptoms that are similar to an RSV
infection.

Symptoms

When a
respiratory syncytial virus (RSV) infection affects
the nose and throat (upper
respiratory system), symptoms are usually mild and
resemble those of the common cold. They include:

Cough.

Stuffy or runny nose.

Mild sore throat.

Earache.

Fever, usually at the beginning of the illness. A high fever does
not mean the illness is more severe.

Babies may have additional symptoms, including:

A decreased interest in their surroundings.

Listlessness and sleepiness.

Fretfulness (irritability) and not sleeping well.

Poor feeding.

Apnea, where breathing stops for about 15 to 20 seconds. This
usually occurs only in babies who were born
prematurely and who also have a history of apnea.

It is hard to distinguish between a common cold and
RSV infection. But unless you or your child has an increased risk of
complications from RSV, it usually is not important to know which virus causes
symptoms.

Coughing that is getting worse. A child may choke or vomit from
intense coughing.

Lethargy, increased tiredness, decreased interest in
surroundings, or loss of interest in food.

What Happens

In healthy children,
respiratory syncytial virus (RSV) infections tend to
be mild and resemble a cold. Children who have only upper
respiratory system symptoms, such as a sore throat or
a runny nose, usually recover in about 10 to 14 days.

Two
different types and many different subtypes (strains) of RSV exist. For this
reason, you cannot have full immunity to the virus and may have many RSV
infections throughout your life. A child's first RSV infection, which almost
always occurs by age 2, usually is the most severe. Certain babies and children have an increased risk of
complications from an RSV infection because of a health condition or another problem. Also, babies have narrow breathing tubes that can clog easily, making
breathing hard. The most common complications for young children are
bronchiolitis and
pneumonia, which are lower respiratory tract
infections.

Adults older than 65 have an increased risk of
complications following infection with RSV. Pneumonia is a particular risk,
especially if other health problems exist, such as
chronic obstructive pulmonary disease (COPD) or
heart failure.

It may take older adults
longer to recover from RSV infection and its complications than people in other age
groups.

What Increases Your Risk

Respiratory syncytial virus (RSV) infects almost all children by the age of 2, and reinfection
throughout life is common. The virus spreads easily and is extremely difficult to
completely avoid. Babies and young children who are in day care centers or
frequently in public places are most likely to become infected, especially
during the peak season.

Older brothers and sisters in school often become
infected with the virus and spread it to other household members, including
babies and preschoolers. Sharing food, touching objects that are contaminated
with the virus, and not washing hands can lead to RSV infection. Older adults
living in nursing homes or other group environments also have a higher risk of
becoming infected with RSV.

Babies ages 2 to 7 months
of age have the highest incidence of RSV infection affecting the lower
respiratory tract. Reinfection with another type or
strain of RSV can occur within weeks. But later infections are usually less
severe.

Watchful waiting

For an otherwise healthy child who has symptoms
of an upper respiratory infection, such as a cough or runny nose, home
treatment usually is all that is needed. But it is important to watch for signs
and symptoms of
complications, such as
dehydration.

Watchful waiting may not be appropriate when your
child with an upper respiratory infection has
an increased risk for complications. Watch your child closely if he or she
has symptoms of an upper respiratory infection. If symptoms get worse or new
symptoms develop, see a doctor right away.

Who to see

Respiratory syncytial virus (RSV) infection can be
diagnosed and treated by a health professional such as a:

Exams and Tests

In otherwise healthy people, it is
not usually necessary to distinguish
respiratory syncytial virus (RSV) infection from a
common cold. A doctor may suspect RSV infection as the cause of symptoms when
there is evidence of a recent community outbreak. It is generally not necessary
to confirm RSV infection with lab tests. But a
medical history and
physical exam may be done to evaluate symptoms.

A
viral detection test may be done to confirm a
diagnosis of RSV in symptomatic
children and
adults older than 65 who are at an increased risk for
a severe infection or for complications. The test involves lab analysis of
nasal drainage, obtained with a cotton swab or nasal
wash. Testing may also be recommended for people who are hospitalized if the
cause of symptoms has not already been determined and they have a high risk of
developing
complications.

The results of viral
detection tests help determine whether precautions are needed to prevent the
spread of infection. For children who are at risk for getting severe infections
or complications of RSV infections, the results of these tests may help guide
treatment, such as the need for medicines.

Certain tests may be
needed if RSV symptoms do not improve or become worse or if complications such
as
bronchiolitis or
pneumonia are suspected. These tests may
include:

Treatment Overview

Respiratory syncytial virus (RSV) infections are usually mild and seem like a common cold. In
most cases, RSV infections go away on their own in about 10 to 14 days. Home
treatment to ease symptoms and prevent
complications is usually all that is needed.

Watch for signs of
dehydration. Signs of dehydration include being thirstier than usual and having darker urine than usual. Make sure to replace fluids lost through
rapid breathing, fever, diarrhea, or vomiting. Encourage more frequent breast-
or bottle-feeding. Avoid giving your baby sports drinks, soft drinks, undiluted
fruit juice, or water. These beverages may contain too much sugar, contain too
few calories, or lack the proper balance of essential minerals (electrolytes).

Make sure you understand whether and when
antibiotics are needed. Antibiotics are not usually
given for RSV infections. But if your child develops complications, such as an
ear infection, your doctor may
prescribe an antibiotic. Do not stop giving antibiotic medicine when your child
starts to feel better. The entire prescription must be taken to completely kill
the bacteria. If you do not give your child all the medicine, the bacterial
infection may return.

Take care of yourself. Caring for a sick child can be
very tiring physically and emotionally. You can best help your child when you
are rested and feeling well.

Treatment for severe infection or complications

Children who develop lower respiratory infections, especially
bronchiolitis, may need medicines such as
bronchodilators in addition to home treatment.
Antibiotics may be used to treat a bacterial infection (such as pneumonia) that develops as a complication. But antibiotics don't treat RSV or any other viral infection.

When complications develop in otherwise healthy children,
corticosteroid medicines sometimes are used. But more
study is needed before corticosteroids are routinely recommended for this
purpose.

A child who is having
difficulty breathing or is
dehydrated may need to be cared for in a hospital. The
child may need
respiratory and other medical treatments. In very rare
cases, some children receive the antiviral medicine
ribavirin while they are in the hospital.

Pregnant women should avoid contact with a child who is
receiving ribavirin.

If your child is in the hospital for RSV, there are
extra measures you can take to make his or her stay
comfortable.

Prevention

Respiratory syncytial virus (RSV) infection is easy to catch (highly contagious). It is common
for children to get viral infections such as RSV if they are often exposed
to infected people and have not built up immunity. There is no sure way to
prevent respiratory illnesses in babies and children.

Sometimes
medicines are used to help
prevent RSV infection in
babies and children who are at risk for complications
from RSV. Even if RSV infection develops, use of these medicines may result in
a less severe infection.

Monoclonal antibodies, such as palivizumab (Synagis), may be used to help prevent
or reduce the severity of RSV infection.

The following may help
reduce your child's risk of respiratory problems:

Wash your hands frequently, and teach your children to
do the same. Also, make sure people who care for your child wash their hands
and understand the importance of this habit in preventing the spread of
infection.

See that your child gets all of his or her vaccines. Diphtheria,
tetanus, and pertussis (DTaP), Haemophilus influenzae type b (Hib), and pneumococcal vaccines are especially important.

Breast-feed your baby for at least the first 6 months after
birth, if possible. Breast milk seems to offer some protection against RSV
infection, but more study is needed.2 Breast milk does
not prevent RSV infection.

Separate a child diagnosed with RSV from others in the home as
much as possible.

If you smoke, quit. If you cannot quit, do not smoke in the
house or car. Secondhand smoke irritates the mucous membranes in your child's
nose, sinuses, and lungs, making him or her more
susceptible to infections.

Outbreaks of RSV often occur between late fall and early
spring. To keep from catching the virus during this time,
limit your exposure to RSV. This is most critical for babies and children who
are at risk for serious RSV infections. Try to
avoid:

Child care centers, malls, movie theaters, and other places where many people are in an enclosed area.

Visiting children who are in the hospital.

Home Treatment

When to use home treatment

Most mild to moderate
respiratory syncytial virus (RSV) infections in
otherwise healthy people are like the common cold and can be treated at home.
If your child is older than 12 months of age and is not at risk for
complications from RSV infection, try home treatment.
But RSV infections in people with an increased risk of complications need close
monitoring.

People who have
impaired immune systems need to see a doctor for
cold symptoms because of the increased risk for complications.
Also,
babies and children—and older adults—who have health problems and other
risk factors should see a doctor at the first sign of RSV.

Antibiotics are not usually
given for viral infections. But if your child develops complications of RSV, such as an
ear infection, your doctor may prescribe an
antibiotic. Do not stop giving antibiotic medicine when your child starts to
feel better. The entire prescription must be taken to completely kill the
bacteria. If you do not give your child all the medicine, the bacterial
infection may return.

Take care of yourself. Caring for a sick child can be
very tiring physically and emotionally. You can best help your child when you
are rested and feeling well.

Medications

Most
respiratory syncytial viral (RSV) infections do not
require prescription medicines. But medicines may be recommended for certain
people to help:

Prevent RSV infection.

Treat RSV infection and its complications.

Medicine choices

A medicine may be given to
infants and children at high risk for complications
of RSV to prevent the infection or reduce its severity.
Monoclonal antibodies, such as palivizumab (Synagis),
are usually given in monthly doses for up to 5 months. This medicine can
stop RSV from multiplying.

Medicines to help treat complications of RSV infection include:

Corticosteroids. These medicines may be used if a
child has an RSV infection and also has
asthma or an allergic-type breathing problem. But
corticosteroids are not used now as often as they were used in the past.

Antibiotics. Antibiotics help the body destroy
bacteria and may be used to help treat or prevent complications that can occur
from RSV.

Bronchodilators. They relax the muscle layer that
surrounds the breathing tubes in the lung, allowing them to expand and move air
more easily. This may help to reduce
wheezing.

What to think about

Ribavirin (Virazole) is an antiviral medicine that is
very rarely used to treat people with RSV infections who have a high risk of
developing complications. Studies so far have provided conflicting evidence
regarding its effectiveness. The doctor will consider the particular
circumstances of the person being treated before making a recommendation about
ribavirin.

Bronchodilators are effective about half the time for
babies.3 Many experts recommend that bronchodilators
be tried initially for babies who are having trouble breathing. If the baby is
able to breathe easier right away, the medicine can be continued.1

Other Places To Get Help

Organizations

HealthyChildren.org

141 Northwest Point Boulevard

Elk Grove Village, IL 60007

Phone:

(847) 434-4000

Web Address:

www.healthychildren.org

This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.

American Lung Association

1301 Pennsylvania Avenue NW

Suite 800

Washington, DC 20004

Phone:

1-800-LUNG-USA (1-800-586-4872) to speak with a lung professional(202) 785-3355

Email:

info@lung.org

Web Address:

www.lungusa.org

The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon,
and ozone.

Centers for Disease Control and Prevention
(CDC)

1600 Clifton Road

Atlanta, GA 30333

Phone:

1-800-CDC-INFO (1-800-232-4636)

TDD:

1-888-232-6348

Web Address:

www.cdc.gov

The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.

KidsHealth for Parents, Children, and
Teens

Nemours Home Office

10140 Centurion Parkway

Jacksonville, FL 32256

Phone:

(904) 697-4100

Web Address:

www.kidshealth.org

This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.

National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health

NIAID Office of Communications and Government Relations

6610 Rockledge Drive, MSC 6612

Bethesda, MD 20892-6612

Phone:

1-866-284-4107 toll-free

Phone:

(301) 496-5717

Fax:

(301) 402-3573

TDD:

1-800-877-8339

Web Address:

www.niaid.nih.gov

The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
immune-system-related diseases.

Other Works Consulted

Committee on Infectious Diseases, American Academy of Pediatrics (2009). Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics, 124(6): 1694–1701.

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How this information was developed to help you make better health decisions.